卵母细胞激活技术在卵细胞质内单精子注射受精失败或低下患者中的应用

目的探讨卵母细胞激活技术在卵细胞质内单精子注射（ICSI）受精失败或低下患者和可疑受精失败或低下患者中的应用价值。方法选择2011年6月至2013年5月至少有1次ICSI受精失败或低下的患者lO例，再次接受助孕治疗时，实施卵母细胞激活技术（作为激活周期）；对可疑ICSI受精失败或低下患者3例，实施半数卵母细胞激活处理，将获得的67枚卵子分为常规ICSI组和激活组。观察卵母细胞激活前后的受精率、卵裂率和优质胚胎的变化及妊娠结局。结果在ICSI受精失败或低下患者中，既往周期的受精率为29．67％（27／91），激活周期的受精率为72．58％（45／62），两者比较，差异有统计学意义（P〈O．01）；既往周期和激活周期的卵裂率分别为85．19％（23／27）和95．56％（43／45），两者比较，差异无统计学意义（P〉0．05）；优质胚胎量由既往IC$I周期的（0．25±0．45）个提高到激活周期的（1．18±1．33）个（P〈0．05）；5例患者获得临床妊娠。在可疑ICSI受精失败或低下患者中，常规ICSI组和激活组的受精率、卵裂率和优质胚胎量比较，差异均无统计学意义（P均〉0．05）。结论卵母细胞激活技术可提高ICSI受精失败或低下史患者的受精率，但是对于没有ICSI受精失败或低下史的患者效果不佳。

Artificial oocyte activation is beneficial for women with total or neartotal fertilization failure after intracytoplasmic sperm injection

Objective To evaluate whether combination of intracytoplasmic sperm injection （ICSI） with arti ficial oocyte activation improves fertilization and pregnancy outcome for women with total or neartotal fertilization failure after ICSI and for women with suspected total or near - total fertilization failure after ICSI. Methods Combi- nation of ICSI with artificial oocyte activation was performed on ten women presenting with a history of total or near - total fertilization failure after ICSI. And it was performed on half of the sibling metaphase lI oocytes and conventional IC- SI on the rest, which was defined as half activation, for three women with suspected total or neartotal fertilization failure after ICSI. The main outcome parameters were fertilization rate, number of high - quality embryos and pregnancy outcome. Results Combination of ICSI with artificial oocyte activation improved fertilization rates in women with total or near- total fertilization failure after ICSI （ 29.67% vs 72.58%, P〈0.01） and the high- quality embryos （0.25±0.45 vs 1.18±1.33, P〈0. 05）. Five women conceived and 1 healthy baby was born. In women with suspected total or near - total fertilization failure after ICSI, the fertilization rate and number of high - quality embryos were no significantly different between artificial oocyte activation group and conventional ICSI group. Conclusion Combination of ICSI with artificial oocyte activation improved fertilization rates and pregnancy outcomes in women with total or neartotal fertilization failure after ICSI. But it was not beneficial for women with suspected total or neartotal fertilization failure after ICSI.